Predictive Value of Liver Stiffness Using FIB-4 Index in Mortality of Heart Failure Patients (Philippine Heart Failure Registry).

BACKGROUND: Heart failure has an in-hospital mortality of 8.2% in the Philippines. The chronic passive congestion caused by heart failure is known to cause liver stiffness, which is proven using ultrasound elastography (US). However, US is not readily available in the Philippines; hence, a scoring system, the FIB-4 index, may have a prognostic value in patient with heart failure. This study aimed to establish the utility of the FIB-4 index as an independent risk factor of mortality in heart failure patients.

METHODS: This was a prospective study that included heart failure patients diagnosed using the Framingham criteria and enrolled in the Philippine Heart Failure Registry. FIB-4 index was computed for each patient and classified as having minimal FIB-4 index (<1.45); moderate (1.46 to 3.25) or advanced (>3.25). Regression analysis was performed to determine the association of FIB-4 index to mortality rate.

RESULTS: Of the 523 patients included in the study, majority were males (59.27%), newly diagnosed with heart failure (54.50%) and had no previous hospitalization (44.9%). Paroxysmal nocturnal dyspnea (82.41%) was the most common major criteria and dyspnea on exertion (88.10%) was the most common minor criteria present. Most complained of dyspnea (59%) on admission. The most common primary etiology of heart failure was hypertensive heart disease (30%). Regression analysis showed a five-fold increased risk of mortality (p=0.0001, 95% CI 2.1-11.7) in patient with FIB-4 index value >3.25, which increased to a 14-fold increase in risk after adjustment for covariates (p=0.0001, 95% CI 3.4-55.63), compared with patients with minimal to moderate FIB-4 index value.

CONCLUSION: Chronic passive congestion of the liver from heart failure leads to liver stiffness and those patients with advanced FIB-4 index value have a 14 times higher risk of mortality compared to those with minimal to moderate FIB-4 index value.